Which plan is right for you?

Let's help you get the best plan!

Essential Advantage®

$22

.93 per month

per month

Individual + 1

$42.99

Individual + 2 or More

$79.31

Annual Max Year 1

$500

Annual Max Year 2

$750

Annual Max Year 3+

$1000

Teeth Whitening

COVERED

Veneers

COVERED

Now offering DeltaVision® in partnership with VSP®

Superior Advantage®

$34

.13 per month

per month

Individual + 1

$64.32

Family

$100.92

Annual Max Year 1

$500

Annual Max Year 2

$1,000

Annual Max Year 3

$1250

Annual Max Year 4+

$1,500

Now offering DeltaVision® in partnership with VSP®

Brighter Advantage®

$37

.47 per month

per month

Individual +1

$71.35

Family

$122.40

Annual Max Year 1

$750

Annual Max Year 2

$1,000

Annual Max Year 3

$1,250

Annual Max Year 4+

$1,500

Teeth Whitening

COVERED

Veneers

COVERED

Braces - All Ages

COVERED

Now offering DeltaVision® in partnership with VSP®

Essential Advantage®

Covered Dental Services

Delta Dental PPO℠ Network

Year One

Years Two & Three

Year Four or more

Annual Maximum Benefits

Contract Year

$500

$750

$1,000

Deductible

Per person / Per family max (contract year; applies to all services except Delta Dental PPO Diagnostic & Preventive services.)

$50 / $150

$50 / $150

$50 / $150

Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

100%

100%

100%

Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments, Repairs, Bleaching & Whitening

25%

50%

80%

Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services, and Veneers

10%

25%

25%

Orthodontia

Braces

Not Included

Not Included

Not Included

Covered Dental Services

Out of Network

Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

10%

10%

10%

Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments, Repairs, Bleaching & Whitening

10%

10%

10%

Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services, and Veneers

10%

10%

10%

Orthodontia

Braces

Not Included

Not Included

Not Included

DeltaVision® I-150 in partnership with VSP®

Monthly Premiums

Individual - $8.14

Individual + 1 - $16.28

Individual + 2 or More - $26.21

WellVision Exam

• Comprehensive eye exam to ensure overall visual wellness

Once every 12 months

$10 Copay

Prescription Glasses

• Includes frames and lenses

$20 Copay

Frames

• $150 allowance for wide selection of frames • 20% savings on amount over allowance • $80 Costco frame allowance

Once every 12 months

Included in Prescription Glasses Copay

Lenses

• Single vision, lined bifocal and lined trifocal lenses

Once every 12 months

Included in Prescription Glasses Copay

Contact Lenses - Instead of Glasses

• $150 allowance for contacts; copay does not apply • Contact lens exam (fitting and evaluation)

Once every 12 months

up to $60 Copay

Featured Frames

$170 allowance on featured frame brands. Check vsp.com for current offers.

Annual Maximum Benefits

Contract Year

Year One $500
Years Two & Three $750
Year Four or more $1,000
Deductible

Per person / Per family max (contract year; applies to all services except Delta Dental PPO Diagnostic & Preventive services.)

Year One $50 / $150
Years Two & Three $50 / $150
Year Four or more $50 / $150
Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

Year One 100%
Years Two & Three 100%
Year Four or more 100%
Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments, Repairs, Bleaching & Whitening

Year One 25%
Years Two & Three 50%
Year Four or more 80%
Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services, and Veneers

Year One 10%
Years Two & Three 25%
Year Four or more 25%
Orthodontia

Braces

Year One Not Included
Years Two & Three Not Included
Year Four or more Not Included
Covered Dental Services

Out of Network

Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

Year One 10%
Years Two & Three 10%
Year Four or more 10%
Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments, Repairs, Bleaching & Whitening

Year One 10%
Years Two & Three 10%
Year Four or more 10%
Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services, and Veneers

Year One 10%
Years Two & Three 10%
Year Four or more 10%
Orthodontia

Braces

Year One Not Included
Years Two & Three Not Included
Year Four or more Not Included
DeltaVision® I-150 in partnership with VSP®

Monthly Premiums

Year One Individual - $8.14
Years Two & Three Individual + 1 - $16.28
Year Four or more Individual + 2 or More - $26.21
WellVision Exam

• Comprehensive eye exam to ensure overall visual wellness

Year One Once every 12 months
Years Two & Three $10 Copay
Year Four or more
Prescription Glasses

• Includes frames and lenses

Year One
Years Two & Three $20 Copay
Year Four or more
Frames

• $150 allowance for wide selection of frames • 20% savings on amount over allowance • $80 Costco frame allowance

Year One Once every 12 months
Years Two & Three Included in Prescription Glasses Copay
Year Four or more
Lenses

• Single vision, lined bifocal and lined trifocal lenses

Year One Once every 12 months
Years Two & Three Included in Prescription Glasses Copay
Year Four or more
Contact Lenses - Instead of Glasses

• $150 allowance for contacts; copay does not apply • Contact lens exam (fitting and evaluation)

Year One Once every 12 months
Years Two & Three up to $60 Copay
Year Four or more
Featured Frames

Superior Advantage®

Covered Dental Services

Delta Dental PPO℠ Network

Year One

Years Two, Three, Four or more

Annual Maximum Benefits

Contract Year

$500

$1,000 | $1,250 | $1,500

Deductible

Per person / Per family max (contract year; applies to all services except Delta Dental PPO Diagnostic & Preventive services.)

$50 / $150

$50 / $150

Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

100%

100%

Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments & Repairs

50%

80%

Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services

25%

50%

Orthodontia

Braces

Not Included

Not Included

Covered Dental Services

Out of Network

Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

80%

80%

Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments & Repairs

40%

60%

Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services

10%

40%

Orthodontia

Braces

Not Included

Not Included

DeltaVision® I-150 in partnership with VSP®

Monthly Premiums

Individual - $8.14

Individual + 1 - $16.28

WellVision Exam

• Comprehensive eye exam to ensure overall visual wellness

Once every 12 months

$10 Copay

Prescription Glasses

• Includes frames and lenses

$20 Copay

Frames

• $150 allowance for wide selection of frames • 20% savings on amount over allowance • $80 Costco frame allowance

Once every 12 months

Included in Prescription Glasses Copay

Lenses

• Single vision, lined bifocal and lined trifocal lenses

Once every 12 months

Included in Prescription Glasses Copay

Contact Lenses - Instead of Glasses

• $150 allowance for contacts; copay does not apply • Contact lens exam (fitting and evaluation)

Once every 12 months

up to $60 Copay

Featured Frames

$170 allowance on featured frame brands. Check vsp.com for current offers.

Annual Maximum Benefits

Contract Year

Year One $500
Years Two, Three, Four or more $1,000 | $1,250 | $1,500
Deductible

Per person / Per family max (contract year; applies to all services except Delta Dental PPO Diagnostic & Preventive services.)

Year One $50 / $150
Years Two, Three, Four or more $50 / $150
Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

Year One 100%
Years Two, Three, Four or more 100%
Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments & Repairs

Year One 50%
Years Two, Three, Four or more 80%
Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services

Year One 25%
Years Two, Three, Four or more 50%
Orthodontia

Braces

Year One Not Included
Years Two, Three, Four or more Not Included
Covered Dental Services

Out of Network

Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

Year One 80%
Years Two, Three, Four or more 80%
Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments & Repairs

Year One 40%
Years Two, Three, Four or more 60%
Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services

Year One 10%
Years Two, Three, Four or more 40%
Orthodontia

Braces

Year One Not Included
Years Two, Three, Four or more Not Included
DeltaVision® I-150 in partnership with VSP®

Monthly Premiums

Year One Individual - $8.14
Years Two, Three, Four or more Individual + 1 - $16.28
WellVision Exam

• Comprehensive eye exam to ensure overall visual wellness

Year One Once every 12 months
Years Two, Three, Four or more $10 Copay
Prescription Glasses

• Includes frames and lenses

Year One
Years Two, Three, Four or more $20 Copay
Frames

• $150 allowance for wide selection of frames • 20% savings on amount over allowance • $80 Costco frame allowance

Year One Once every 12 months
Years Two, Three, Four or more Included in Prescription Glasses Copay
Lenses

• Single vision, lined bifocal and lined trifocal lenses

Year One Once every 12 months
Years Two, Three, Four or more Included in Prescription Glasses Copay
Contact Lenses - Instead of Glasses

• $150 allowance for contacts; copay does not apply • Contact lens exam (fitting and evaluation)

Year One Once every 12 months
Years Two, Three, Four or more up to $60 Copay
Featured Frames

Brighter Advantage®

Covered Dental Services

Delta Dental PPO℠ Network

Year One

Years Two, Three, Four or more

Annual Maximum Benefits

Contract Year

$750

$1,000 | $1,250 | $1,500

Deductible

Per person / Per family max (contract year; applies to all services except Delta Dental PPO Diagnostic & Preventive services.)

$50 / $150

$50 / $150

Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

100%

100%

Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments & Repairs

50%

80%

Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services, Bleaching, Whitening, and Veneers

25%

50%

Orthodontia

Braces

Not Included

50%

Covered Dental Services

Out of Network

Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

80%

80%

Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments & Repairs

40%

60%

Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services, Bleaching, Whitening, and Veneers

10%

40%

Orthodontia

Braces

Not Included

40%

DeltaVision® I-175 in partnership with VSP®

Monthly Premiums

Individual - $11.73

Individual + 1 - $23.46

WellVision Exam

• Comprehensive eye exam to ensure overall visual wellness

Once every 12 months

$10 Copay

Prescription Glasses

• Includes frames and lenses

$10 Copay

Frames

• $175 allowance for wide selection of frames • 20% savings on amount over allowance • $95 Costco frame allowance

Once every 12 months

Included in Prescription Glasses Copay

Lenses

• Single vision, lined bifocal and lined trifocal lenses

Once every 12 months

Included in Prescription Glasses Copay

Contact Lenses - Instead of Glasses

• $195 allowance for contacts; copay does not apply • Contact lens exam (fitting and evaluation)

Once every 12 months

up to $60 Copay

Featured Frames

$170 allowance on featured frame brands. Check vsp.com for current offers.

Annual Maximum Benefits

Contract Year

Year One $750
Years Two, Three, Four or more $1,000 | $1,250 | $1,500
Deductible

Per person / Per family max (contract year; applies to all services except Delta Dental PPO Diagnostic & Preventive services.)

Year One $50 / $150
Years Two, Three, Four or more $50 / $150
Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

Year One 100%
Years Two, Three, Four or more 100%
Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments & Repairs

Year One 50%
Years Two, Three, Four or more 80%
Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services, Bleaching, Whitening, and Veneers

Year One 25%
Years Two, Three, Four or more 50%
Orthodontia

Braces

Year One Not Included
Years Two, Three, Four or more 50%
Covered Dental Services

Out of Network

Diagnostic & Preventive Services

Exams*, Cleanings*, Fluoride, Space Maintainers, Brush Biopsy, X-rays, Periodontal Maintenance

Year One 80%
Years Two, Three, Four or more 80%
Basic Services

Emergency Palliative Treatment, Sealants, Minor Restorative Services (Fillings), Simple Extractions, Other Basic Services, Adjustments & Repairs

Year One 40%
Years Two, Three, Four or more 60%
Major Services

Crown Repair, Endodontic Services, Periodontic Services, Other Oral Surgery, Major Restorative Services, Relines & Rebase, Implants, Prosthodontic Services, Bleaching, Whitening, and Veneers

Year One 10%
Years Two, Three, Four or more 40%
Orthodontia

Braces

Year One Not Included
Years Two, Three, Four or more 40%
DeltaVision® I-175 in partnership with VSP®

Monthly Premiums

Year One Individual - $11.73
Years Two, Three, Four or more Individual + 1 - $23.46
WellVision Exam

• Comprehensive eye exam to ensure overall visual wellness

Year One Once every 12 months
Years Two, Three, Four or more $10 Copay
Prescription Glasses

• Includes frames and lenses

Year One
Years Two, Three, Four or more $10 Copay
Frames

• $175 allowance for wide selection of frames • 20% savings on amount over allowance • $95 Costco frame allowance

Year One Once every 12 months
Years Two, Three, Four or more Included in Prescription Glasses Copay
Lenses

• Single vision, lined bifocal and lined trifocal lenses

Year One Once every 12 months
Years Two, Three, Four or more Included in Prescription Glasses Copay
Contact Lenses - Instead of Glasses

• $195 allowance for contacts; copay does not apply • Contact lens exam (fitting and evaluation)

Year One Once every 12 months
Years Two, Three, Four or more up to $60 Copay
Featured Frames

Rates include a monthly transaction fee of $2.50. You will be charged a $25 application fee at enrollment. Rates valid through 12/31/19.

*Limited to two per person in a 12-month period. Persons with certain medical conditions may be eligible for more.

See the Schedule of Benefits for this policy for a comprehensive explanation of services covered and not covered.

Who is eligible?

Membership is open to all Tennessee adult residents and their dependents. If you have been covered by a Delta Dental of Tennessee individual policy and drop your coverage, you cannot re-enroll for 12 months.

When do my benefits start?

Your benefits for either plan will become effective the first day of the month following receipt of application, $25 application fee, and initial premium if received on or before the 15th of the month. If received after the 15th, effective date will be the first day of the following month.

Find an Eye Doctor Near You!

When it comes to choices, VSP has your eyes covered. With a large network of independent doctors and popular retailers, a VSP doctor is always near. All DeltaVision doctors a part of VSP's "Choice" network.